Approximately 1 in 5 gynaecological out-patient referrals are for heavy periods of menorrhagia. The definition of menorrhagia is heavy menstrual loss in the absence of any organic pathology. This condition affects many thousands of women in the UK annually, and the usual course of action is to treat these women is either to use drugs (whose effects are temporary and are very expensive,) or to perform a hysterectomy. Abdominal hysterectomy is the single most commonly performed abdominal surgical procedure in the UK. However, the operation is associated with a definite mortality rate (between 0.01 and 0.03%) and moreover there is a significant morbidity associated with this operation both in terms of hospital stay (7-10 days), and more importantly, specific complications. In particular, the urinary tract is susceptible to damage by surgical intervention and this has been estimated as occurring at a rate of between 0.5% and 1% in one series of hysterectomies.
Whilst hysterectomy has been the most commonly performed abdominal operation in the UK, 90% of uteri removed because of excessive menstrual loss are histologically and morphologically normal.
The cost of hysterectomising women with menorrhagia is enormous both in terms of operating time, convalescence in hospitals (approximate 7-10 days), and morbidity associated with the operation for up to one year afterwards.
Several attempts have been made over the last 40 years to inactivate the endometrium from which the heavy menstrual loss originates without actually removing the uterus. There are two commonly employed methods at the present time in which there has been enormous interest. The first is the use of the neodymium yttrium aluminium garnet (Nd-YAG) laser system which is hysteroscopically directed at the endometrium and is used to vaporise the endometrium. The second is the hystero-resectoscope which is a modified diathermy loop device similar to a urological resectoscope, where the endometrium is excised, again under direct vision.
Although these two methods of treatment would appear to be effective no one has yet demonstrated conclusive results. Moreover both operations require a highly skilled operative hysteroscopist and both take a considerable amount of time to perform, approximately one hour.
Most importantly of all, both procedures require irrigation of the endometrium cavity with a non-conductive solution such as glycine. Once venules in the endometrium and myometrium are breached, glycine which is highly toxic intravasates, and deaths have been reported due to this.